Changes in physical activity, dietary behaviours, and BMI among undergraduate health students before, during, and after the COVID-19 lockdown: a follow-up study

Introduction: India reported over 30 million confirmed COVID-19 cases and nearly 400000 deaths. The nationwide lockdown beginning on March 25, 2020, and prolonged campus closures led to remote-learning, restricted mobility, and limited access to healthy foods among students. Understanding these lifestyle changes in health-professional students who will guide future patients is essential. Objective: To assess changes in physical activity, dietary behaviours, and body mass index (BMI) among undergraduate health students before, during, and after the COVID-19 lockdown. Methods: A follow-up observational study was conducted among final-year MBBS, BDS, BPT, and BPharm students at a tertiary medical university in South India. All eligible students (N=550) were approached; 470 consented. Pre-lockdown weight and height were obtained by recall, while weight and height were measured during lockdown and weight re-measured after lockdown (September 2021 onwards). Physical activity was assessed using the International Physical Activity Questionnaire–Short Form (IPAQ-SF), and dietary behaviours with a pre-tested semi-structured questionnaire. Descriptive statistics, paired t-tests, repeated measures ANOVA, and multiple linear regression were performed. Results: Mean BMI remained unchanged from pre- to during lockdown but decreased significantly afterwards, while still slightly exceeding baseline values (p < 0.001). Physical activity (MET-min/week) declined significantly during lockdown compared with baseline (mean difference –364.78, p < 0.001). Stress eating (40%), night-time eating (34.3%), and increased junk food intake (24.9%) were reported. Regression analysis identified physical activity change (β = –0.252, p < 0.001) and fitness app use (β = –0.219, p = 0.017) as protective against BMI gain, whereas increased meal frequency predicted higher BMI (β = 0.088, p = 0.048). Model explained 8.7% of variance in BMI change. Conclusion: COVID-19 lockdown led to reduced physical activity and altered dietary behaviours among health-professional students, producing modest but sustained BMI increases. Student-focused health-promotion strategies and digital tools to maintain activity are warranted.